NDIA Accountability Project

Concerns regarding independent assessments impacting ATSI patients' access to NDIS supports

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RE: Submission to the Joint Standing Committee on the

NDIS: Independent Assessments.

  • The implications of independent assessments for access to and eligibility for the NDIS;
  • The implications of independent assessments for NDIS planning, including decisions related to funding reasonable and necessary supports;
  • The circumstances in which a person may not be required to complete an independent assessment;
  • Opportunities to review or challenge the outcomes of independent assessments;
  • The appropriateness of independent assessments for particular cohorts of people with disability, including Aboriginal and Torres Strait Islander peoples, people from regional, rural and remote areas, and people from culturally and linguistically diverse backgrounds;
  • The appropriateness of independent assessments for people with particular disability types, including psychosocial disability;

Dear Committee Secretary,

Concerns Regarding Implementation of Independent Assessments

I am a General Practitioner working at the Victorian Aboriginal Health Service and am writing to express my concerns regarding the proposed implementation of the independent assessments and how I believe they will negatively impact some of my patients and become a barrier to access of the NDIS. I write as a health professional based on my personal and professional observations in the work I have done and as an Ally of our Aboriginal and Torres Strait Islander (ATSI) communities.

I have worked as a doctor and GP for 20 years in a range of roles caring for people with different disabilities in both pre and post NDIS timeframes. This has included caring for members of the Stolen Generation of our first nations communities and also patients from many backgrounds who have been significantly impacted by psychosocial and physical trauma in their life as have subsequently had significant disability secondary to mental health issues or acquired brain injuries. My work in this area has highlighted to me the importance of long term therapeutic relationships in building trust, understanding nuances of communication, creating culturally safe spaces and ensuring patients feel safe and confident enough to appropriately express their needs and concerns.

The committee will already be aware, I am sure, that First Nations community members are underrepresented in NDIS participation (6.6-9% of participants: 2020 NDIS report)) despite having an increased burden overall of disability compared to the non First Nations populations (2015 ABS data suggests ATSI people 1.8 times more likely to have a disability). The Independent assessment process, I believe, will further increase barriers to access and will further exacerbate the health and social inequalities we already see in ATSI communities and negatively impact the Closing the Gap targets. In fact it will be a double disadvantage, given the Australian Human Rights commission notes that people living with a disability are “more likely to experience poverty, live in poor quality or insecure housing and have low levels of education. They are often socially isolated, with fewer opportunities to take part in community life”. (https://humanrights.gov.au/our-work/education/face-facts-disability-rights )

A very useful insight into challenges already existing for ATSI communities accessing NDIS is seen in project undertaken by the Centre for Health Policy, University of Melbourne, School of global and population health.

https://www.lowitja.org.au/content/Document/PDF/DIS_Evaluation_M_Kelaher_v2.pdf

The project was titled, Understanding disability through the lens of Aboriginal and

Torres Strait Islander people – challenges and opportunities.

In May 2019, the final report was released which I feel highlights how the NDIA has struggled to implement its own performance standards in engaging ATSI communities (Pages 59-63). I believe the Independent assessments will further move away from engaging local communities and teams of current care providers who have often known their patients/clients over an extended period of time, who the clients trust and who can support them in advocating for needs and care.

As a result of my experience working with patients in this space, I find it very difficult to believe that the independent assessment process in its current form, would be culturally safe or an appropriate way to ensure clients are best able to express their needs and formulate what they feel they need from the NDIS to live full and complete lives. As the above noted report documents;

“Another challenge facing the NDIA, though not specific to the NDIS, is Aboriginal and Torres Strait Islander people’s fear, mistrust and/or hesitance to engage with government agencies or support providers, consequent to intergenerational and historical racist treatment, social exclusion and discrimination experienced by Aboriginal and Torres Strait Islander communities. Therefore, it needs to be acknowledged that changing the patterns of mistrust within these contexts will necessitate a broad systemic and ecological change that incorporates trauma-informed approaches at individual, family, community and policy levels. (Page 17)

I understand that there will be a standardised assessment process that will be undertaken by allied health professionals working for companies contracted by the National Disability Insurance Agency (NDIA) who the patient/Client does not know. These assessors will perform in-home evaluations. It will be conducted over three hours and will include interviews and an evaluation of the applicant’s ability to perform everyday household tasks.

I can assure the committee, that in my experience, very few of my patients, especially those from the Stolen Generation, would feel comfortable allowing an assessor they do not know into their home nor would they feel comfortable revealing very intimate personal information to stranger about their home environment and how they are managing. In fact, I would argue this could be extremely traumatic and triggering for those who have a deep mistrust of government institutions.

I am deeply concerned that a one size fits all approach to assessment for the NDIS under these proposed changes does not appreciate individual needs of participants from different backgrounds and disabilities and will therefore undermine the enormous benefits the NDIS can bring to those trying to access the program.

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I hope that the Joint Standing Committee will seriously consider the points I raise and ensure more time is spent liaising with all stakeholders, and particularly from ATSI communities. Any proposed changes to the assessment process must not add further barriers to access that will exclude full participation by ATSI people living with a disability and must not further increase inequality and disparity in the community.

Yours Sincerely,

Dr Debra Blackmore,

MBBS/FRACGP